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Forget Nots > Head & Neck > Flashcards

Head & Neck Flashcards

1
Q

Subclavian structures from anterior to posterior

A 
Subclavian vein
Phrenic nerve
Anterior scalene
Subclavian artery
Brachial plexus
Middle scalene
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2
Q

Recurrent laryngeal innervates everything but this muscle?

What innervates this muscle?

A

Cricothyroid muscle.

Superior laryngeal nerve. Affects voice tone, high pitches

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3
Q

Treatment strategy for oral squamous cell CA based on size

A

> 4cm or node involvement -> WLE, modified radical neck dissection, adjuvant XRT

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4
Q

Salivary gland tumors.

  • Most common malignant tumor? #2 most common malignant?
  • MC benign tumor?
  • Treatment for malignant salivary gland tumor? What if it’s invading the facial nerve?
A
  • Most common malignant: mucoepidermoid. #2: adenoidcystic
  • Most common benign: pleomorphic adenoma
  • Rx: total parotidectomy with facial n. preservation, ipsilateral modified radical neck dissection, post-op XRT. If it involves the facial, you can get away with XRT only
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5
Q

Palpable node in the neck. Bx shows cancer. Unkn primary.

  • What to do next?
  • What is the most common site for unknown h&n primary?
  • what is the treatment?
A

FNA of regional nodes
CT of head neck, chest +/-PET
OR for direct laryngoscopy, directed biopsies

  • tonsil, followed by base of the tongue.
  • have to take pt to OR regardless. Do ipsilateral modified radical neck dissection, bilateral XRT
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6
Q

Most common site for oral cavity cancer. Why.

When to do flap reconstruction

A

Lower lip. Sun exposure.if over half of the lip is resected then reconstruct

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7
Q

Painless protuberance in the bony part of the mouth. Treatment?

A

Torus peletinus. Do nothing

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8
Q

Ebstein barr associated with what head and neck cancer? Treatment?

A

Nasopharyngeal squamous cell cancer

Radiation

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9
Q

What is Frey syndrome? Why/how does it happen?

A

Auriculotemporal nerve injury. Interacts with the sympathetics

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10
Q

Post-op lap CCY. High fevers and big swelling at the angle of the jaw. What is it? What organism? Treatment?

A

Suppurative parotiditis. Staph aureus

Abx, supportive care. I&D if collection

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11
Q

What is the most common original of the brachial cleft cyst?

A

2nd arch

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12
Q

The tract of the brachial cleft cyst goes over or under cranial nerve 12?

Over or under cranial nerve 9?

Relation to internal and external carotid?

Relation to SCM?

Ultimately goes into what structure?

A 
Over CN12
Over CN9
Between the bifurcation
Anterior to SCM
ultimately goes into the tonsil
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13
Q

The entire thyroid gland rises from the thyroglossal duct tract except for what part?

A

The tubercle of zuckerkandl which rises from the 4th pouch along with the superior paras

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14
Q

Sarcoidosis is caseating or non-caseating granulomatous changes?

A

Non-caseating.

Caseating: TB

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15
Q

If you biopsy a head and neck lymphadenopathy and see metastatic cancer? What is the most likely primary?

A

Squamous cell CA of upper aerodigestive tracts

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16
Q

What is the T staging for any head and neck tumors?

A

T1: <2 cm
T2: 2-4 cm
T3: >4 cm
T4: any that invades adjacent structures

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17
Q

Treatment regimen for head and neck cancer based on T staging?

Given that the pt doesn’t have any physical exam or CT findings of nodes, what do you do with neck for each of the T stages?

A

T1 - T2: surgery

T3 - T4: surgery with post-op radiation or chemo

Only T2 lesions needs b/l neck dissection.

T1: low chance of nodal disease
T2: 30% chance of nodal disease
T3-T4: you’re giving post-op radiation anyway

18
Q

What is the main complication from radiation to face/mouth cancer?

A

Osteoradionecrosis. Bone becomes necrotic. Gets infected

19
Q

CT size cutoff for neck nodes

A

N1: < 3 cm
N2: 3-6 cm
N3: >6 cm

N2a: 3-6cm single node
N2b: multiple nodes
N2c: contralateral node

20
Q

What does the accessory nerve innervate?

A

Trapezius and SCM

21
Q

Which type of thyroid cancer most likely to be when there’s calcifications in the thyroid?

A

Papillary

22
Q

80% of parotid tumors are benign or malignant?

What is the most common benign tumor?

What is the most common malignant tumor?

A

80% of parotid is benign

Most common benign: pleomorphic adenoma

Most common malignant: mucoepidermoid carcinoma

23
Q

Do cystic hygromas carry any malignancy risk?

Can they be diagnosed on prenatal ultrasound?

A

No

Yes

24
Q

Which organ do you need to take out when removing a 3rd and 4th branchial remnant?

What about 2nd remnant?

A

3rd and 4th: thyroid

2nd: tonsil

25
Q

T/F: acutely infected branchial cleft cyst needs immediate operation

The incision should be (transverse/longitudinal) over the cyst

A

F. Abx for several weeks first

Transverse incision will improve cosmesis

26
Q

What are the borders of the submental triangle

A

Anterior belly of the digadtrics
Hyoid bone
Symphysis menti

floor: mylohyoid

27
Q

“pushing edges” on the histological exam rather than invading

A

Verrucous carcinoma. It’s a variant of the sq cell ca

28
Q

Most common site of minor salivary gland malignancies?

A

Palate. 50% of all minor salivary gland malignancy

29
Q

Why should you never do a cric in kids?

A

Cricoid cartilage is the narrowest part of the airway in kids. It’ll cause airway stenosis

> 12yo you can do it

30
Q

What the F is frey syndrome?

How do you treat it?

A

Sweating and flushing of a patch of skin near the ear that occurs when someone is eating

It occurs due to inappropriate regrowth of the parasympathetic auriculotemporal nerve into the sweat glands overlying the parotid gland

Apply antiperspirant to involved skin

31
Q

What innervates the sensation over the skin behind ears?

A

Greater auricular nerve

32
Q

Parathyroid cancer carries worse prognosis for

  • men vs women?
  • young age vs old age at diagnosis?
A
  • men are worse

- old age at diagnosis is worse

33
Q

What are the borders of the submandibular triangle?

A

Anterior belly, posterior belly of the digadtrics, Mandible.

This is the triangle right next to the submantle triangle
Hyoid bone
Anterior digadtrics

34
Q

What is the most common incision for parotid surgery?

A

Modified Blair incision

Starts in the preauricular skin and extends around the lobule over the mastoid tip then curves around down the neck

35
Q

What is the second most common benign parotid gland

A

Monomorphic adenoma aka warthin tumor

36
Q

Open trach vs perc trach.

Difference in icu los? Cost? Infection rate?

A

Only difference is lower infection rate in perc trach

37
Q

What is the N staging for head and neck cancer?

A

N1: single ipsilateral node < 3cm
N2: single ipsilateral node 3 - 6cm OR multiple ipsilateral nodes or bilateral
N3: > 6cm

38
Q

Enlarging parotid gland mass with facial droop. Is it pleomorphic adenoma?

A

No. When it’s enlarging and facial droop think cancer. Mucoepidermoid is most common

39
Q

Most common morbidity after radical neck dissection?

A

Shoulder dysfunction because of accessory nerve

Denervated trapezius. Frozen shoulder

40
Q

What forms the floor of the submental triangle?

A

Mylohyoid muscle

41
Q

Typically where is the facial nerve trunk in relation to

Tragal pointer?

Tympanomastoid suture line?

A

1cm inferior to the tragal pointer

6-8mm below the tympanomastoid suture line at the lvl of the belly of the posterior digastric muscle.

42
Q

For parotidectomy, what is the rate of facial nerve dysfunction?

What is the prognosis once you get facial nerve dysfunction? What is the rate of permanent dysfunction?

A

20-40%. Very common

Prognosis: most recover within a year. Permanent dysfunction only 4%

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